Yilmazlar A, Yilmazlar T, Gürpinar E, Korun N, Kutlay O
Department of Anaesthesiology, Uludag University School of Medicine, Bursa, Turkey.
J Int Med Res. 1996 May-Jun;24(3):266-70. doi: 10.1177/030006059602400305.
Post-operative vomiting, especially in ambulatory surgical patients, remains a troublesome problem. This placebo-controlled, randomized, prospective double-blind trial was designed to evaluate the efficacy of two prophylactic anti-emetic regimens on post-operative vomiting in 1-day thyroid surgery. Altogether 60 elective surgical patients were followed for 4 h post-operatively. All patients were American Society of Anesthesiologists physical status of I or II and aged between 22 and 60 years: group 1 was saline control; in groups 2 and 3, metoclopramide (0.2 mg/kg) or tropisetron (5 mg) was administered, respectively, as an intravenous single dose during induction. Patients were pre-medicated. A standardized anaesthetic technique consisting of thiopentone-succinylcholine for induction and fentanyl-nitrous oxide-halothane-pancuronium for maintenance of anaesthesia was used. A 'rescue' anti-emetic was provided in case of continued vomiting or at the patient's request. Anti-emetic inefficacy was defined as request for rescue anti-emetic and/or vomiting episode during the first 4 h post-operation. The number of patients vomiting was 12/20 (60%), 10/20 (50%) and 1/20 (5%) within the first 2 h post-operation in groups 1, 2 and 3, respectively (P > 0.05 for groups 1 and 2; P < 0.01 for groups 2 and 3; P < 0.001 for groups 1 and 3). In group 2, three patients required rescue medication during the first 2 h post-operation, but no significant difference was observed between groups 2 and 3 (P > 0.05). None of the cases in any of the groups needed any rescue medication during post-operative 2-4 h. It is concluded that tropisetron is a highly effective anti-emetic drug in the prophylaxis of post-operative vomiting.
术后呕吐，尤其是在门诊手术患者中，仍然是一个棘手的问题。这项安慰剂对照、随机、前瞻性双盲试验旨在评估两种预防性止吐方案对甲状腺一日手术术后呕吐的疗效。总共60例择期手术患者术后随访4小时。所有患者美国麻醉医师协会身体状况分级为I或II级，年龄在22至60岁之间：第1组为生理盐水对照；第2组和第3组在诱导期分别静脉单剂量给予甲氧氯普胺（0.2mg/kg）或托烷司琼（5mg）。患者术前用药。采用硫喷妥钠-琥珀酰胆碱诱导、芬太尼-氧化亚氮-氟烷-泮库溴铵维持麻醉的标准化麻醉技术。若持续呕吐或患者要求，可给予“解救”止吐药。止吐无效定义为术后前4小时内需要解救止吐药和/或发生呕吐发作。术后第1个2小时内，第1组、第2组和第3组呕吐患者人数分别为12/20（60%）、10/20（50%）和1/20（5%）（第1组和第2组P>0.05；第2组和第3组P<0.01；第1组和第3组P<0.001）。第2组有3例患者在术后第1个2小时内需要解救药物，但第2组和第3组之间未观察到显著差异（P>0.05）。术后2至4小时内，任何一组均无病例需要任何解救药物。结论是托烷司琼是预防术后呕吐的高效止吐药。
